Addressing Issues

Improving Cultural Competency

Cultural competence can have a real impact on clinical outcomes. It relates to the ability of health care professionals to understand and respond effectively to the cultural and linguistic needs of patients in the health care setting. It enhances the physician-patient relationship through communication and the effective use of language. Respect is at the heart of cultural competence.

Practical Tips for Clinicians

A newsletter article for clinicians, “Cultural Competency in Practice” by Jennie McLaurin, MD, FAAP*, provides practical tips to help clinicians draw out culture-bound perspectives on illness by asking good questions:

• What do you think caused this problem?
• What have you done to treat this?
• Have you asked anyone else to help you?
• What are some of the ways your parents might have treated this? Traditional ways of treating this?
• What do you want the medicine to do? What medicine do you believe works best for you? Why?
• How does your faith/religion help you to be well?
• Are there any foods or drinks that you know of that will help you with____?

There are many such questions that can be asked. The conversation can be as brief or complex as the clinician determines. Each patient-centered encounter is unique and recognizes the patient’s individuality. The approach helps to avoid stereotyping and allows for collaboration and negotiation. *www.migrantclinician.org/files/streamline/20020304_mcn_streamline.pdf

Cultural Competency Information from Health Care Professional Organizations

The following health care professional organizations have published guidelines, policies, or material relating to the care of culturally diverse populations:

American Academy of Family Physicians www.aafp.org/online/en/home.html
Quality Care for Diverse Populations Video www.aafp.org/online/en/home/cme/selfstudy/qualitycarevideo/videos.html
A training program to assist physicians and other health care professionals become more culturally proficient in the provision of patient care. It includes five video vignettes, written materials, tools and to enhance patient encounters, and a list of resources.

American Academy of Pediatrics aappolicy.aappublications.org

American Association of Diabetes Educators
Position statement “Cultural sensitivity: definition, application, and recommendations for diabetes educators” Diabetes Educator, 2002;28(6):922-7. tde.sagepub.com/cgi/pdf_extract/33/1/41

American College of Obstetrics and Gynecology www.acog.org/departments/dept_notice.cfm?recno=10&bulletin=1636

American Medical Association
www.ama-assn.org/ama/pub/category/9913.html
The Health Literacy: Help Your Patients Understand Educational Kit A health literacy Continuing Education toolkit for health care providers that includes a documentary and instructional video and an in-depth manual for clinicians.

American Psychiatric Association www.psych.org

Society of Teachers of Family Medicine www.stfm.org/corep.html

Health Resources and Services Administration (HRSA) Practice and Perspectives

www.hrsa.gov/culturalcompetence/
HRSA has a long-standing interest in cultural competence because so many of its grantees provide care to traditionally underserved populations that include culturally and linguistically diverse communities. HRSA programs that most successfully provide culturally competent services tend to:

• Define culture broadly
• Value clients’ cultural beliefs
• Recognize complexity in language interpretation
• Facilitate learning between providers and communities
• Involve the community and address service needs
• Collaborate with other agencies
• Professionalize staff hiring and training
• Institutionalize cultural competence

Cultural Competence Resources for Health Care Providers
www.hrsa.gov/culturalcompetence/
Resources include assessment tools, language/culture specific materials, and health care professional materials.

Additional Resources

1. The Provider's Guide to Quality and Culture from the Bureau of Primary Health Care and others. This comprehensive guide assists health care organizations to develop attitudes, skills, behaviors, and policies that enable staff to work effectively in cross-cultural situations. It includes perspectives on African Americans, American Indian and Alaska Natives, Asian Americans, Hispanic/Latinos, and Pacific Islanders.
   erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=English
    
2. Office of Minority Health
   minorityhealth.hhs.gov/templates/browse.aspx?lvl=1&lvlID=3
   This website provides a comprehensive view of cultural competency in health care delivery. It includes:
   • guides to help healthcare organizations plan, implement, and evaluate language access services for limited-English-proficient patients
   • an education program for nurses
   • National Standards on Culturally and Linguistically Appropriate Services (CLAS)
      
3. The University of Arizona Hispanic Center of Excellence is part of a national effort funded by the Department of Health and Human Services - Health Resources and Services Administration to help improve the cultural competency of health care services for Latino/Hispanic communities. The site provides reports, links, and resources. www.hispanichealth.arizona.edu/culturalcompetency.html
    
   A Primer for Cultural Proficiency: Towards Quality Health Services for Hispanics for medical care providers, developed by the National Alliance for Hispanic Health. www.hispanichealth.arizona.edu/Primer for Culural Proficiency NAHH.pdf
    
4. The Agency for Healthcare Research and Quality (AHRQ)
   National Healthcare Disparities Report www.ahrq.gov/qual/qrdr09.htm. A fact sheet, "Diabetes Disparities among Racial and Ethnic Minorities." www.ahrq.gov/research/diabdisp.pdf
    
5. Language Service Action Kit, 2004
   From the Access Project at Brandeis University.
   www.accessproject.org/adobe/language_services_action_kit.pdf
    
6. Michigan Diabetes Research and Training Center Videotapes
   www.med.umich.edu/mdrtc/profs/index.htm#cbv
   A set of videotapes and a discussion guide for diabetes educators to provide culturally sensitive and relevant diabetes education for urban African Americans with diabetes.
    
7. Tufts University's Health Sciences Library Health Resource for Asian Americans spiral.tufts.edu Offers patient health information including diabetes in several Asian languages.
    
8. Article
   Goody CM, Drago L: Using cultural competence constructs to understand food practices and provide diabetes care and education. Diabetes Spectrum 2009; 22(1): 43-47. spectrum.diabetesjournals.org/content/22/1/43.full.pdf+html

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